Chronic Actinic Dermatitis Revisited

Chronic actinic dermatitis (CAD) is a persistent eczematous photodermatitis classically described in older, white men with contact allergy to plants. However, evidence from recent studies suggests that some demographics of CAD patients may be changing.

The aims of the study were to determine the frequency of CAD in patients presenting with photosensitive eruptions and to identify the allergens and photoallergens most closely associated with this condition.

We identified all patients with a diagnosis of CAD from 246 consecutive records of patients undergoing photopatch testing from July 1994 to June 2018 and summarized the demographics and test results in comparison with non-CAD patients.

Nineteen (7.7%) of the 246 patients evaluated had CAD with a male-to-female ratio of 1:1.7 among CAD patients. Compared with non-CAD patients, photocontact allergy and/or contact allergy to sesquiterpene lactone mix and contact allergy to fragrances were significantly more common in CAD. Contact allergy to p-phenylenediamine was also common. The results of this study suggest that CAD presents in a broader demographic range, including both men and women of both light and dark skin types. Phototesting and photopatch testing should be considered when patients present with clinical findings consistent with CAD.